A 47-year-old male was referred to Emergency Department of our hospital for acute urinary retention. Physical examination showed electrical cable with proximal part introduced into the urethra. Plain abdominal radiograph demonstrated a metallic object in the pelvis and the patient underwent an operation. We used suprapubic cystostomy approach, and the wire was removed from the bladder and urethra.Muškarac u dobi od 47 godina upućen je na hitni odjel naše bolnice zbog akutnog zadržavanja mokraće. Fizikalnim pregledom otkriven je električni kabel koji je dijelom bio uvučen u uretru. Radiografski pregled trbuha pokazao je metalni predmet u zdjelici, pa je bolesnik podvrgnut operacijskom zahvatu. Primijenili smo pristup suprapubičnom cistostomom i uklonili žicu iz mjehura i uretre

Anton Maričić

Kristian Krpina

Maksim Valenčić

Romano Oguić

Stanislav Sotošek

Željko Fučkar

English

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Acta Clin Croat,  Vol. 48,  No. 3,  2009 177Acta Clin Croat 2010; 49:177-179 Case ReportAN UNUSUAL CASE OF ACUTE URINARY RETENTIONKristian Krpina, Stanislav Sotošek, Romano Oguić, Anton Maričić, Maksim Valenčić and Željko FučkarUniversity Department of Urology, Rijeka University Hospital Center, Rijeka, CroatiaSUMMARY – A 47-year-old male was referred to Emergency Department of our hospital for acute urinary retention. Physical examination showed electrical cable with proximal part introduced into the urethra. Plain abdominal radiograph demonstrated a metallic object in the pelvis and the patient underwent an operation. We used suprapubic cystostomy approach, and the wire was remo-ved from the bladder and urethra. Key words: Foreign bodies – complications; Foreign bodies – surgery; Foreign bodies – psychology; Ure-thra – radiography; Urethra – surgery; Case reportCorrespondence to: Kristian Krpina, MD, University Department of Urology, Rijeka University Hospital Center, Tome Strižića 3, HR-51000 Rijeka, CroatiaE-mail: kristiank@net.hrReceived October 5, 2009, accepted April 9, 2010IntroductionAcute urinary retention is a common urologic emergency in men. Th ere are several possible causes of acute urinary retention such as α-adrenergic activity, sensory/motor defi cit, prostatic infl ammation, bladder overdistention, drugs and mechanical obstruction. Here we present an unusual case of acute urinary re-tention caused by insertion of a foreign body into the genitourinary tract.Case ReportA 47-year-old male was referred to Emergency Department of our hospital for acute urinary reten-tion in August 2005. Th e patient reported painful in-ability to pass urine and denied any other subjective complaints. Th e patient’s past medical and surgical history was not contributory. Physical examination showed some kind of electrical cable with its proximal part introduced into the urethra (Fig. 1). Th e patient showed no anxiety or attempt to avoid genital or rectal examination.Plain abdominal radiograph demonstrated a for-eign metallic object in the pelvis and the patient un-derwent an operation (Fig. 2). Upon demonstrating the foreign body to have reached the pelvis, we used midline lower abdominal extraperitoneal incision with suprapubic cystostomy approach. After incision on the anterior bladder wall and entering the bladder, we exposed intravesical knotting of a wire object (Fig. 3). We used strong cutting forceps to cut the wire at the level of bladder neck. One part of the wire was re-moved from the bladder and the other part was gently pulled from the urethra (Fig. 4). Before closing the wound, we inserted urethral catheter (Foley type) and drain through the wound. Fig. 1. Black electrical cable protruding from the external urethral meatus.K. Krpina et al.  An unusual case of acute urinary retention 178 Acta Clin Croat,  Vol. 49,  No. 2,  2010Th e patient was discharged from the hospital on day seven. DiscussionCases of foreign bodies in the genitourinary tract are always of interest because they occur with such Fig. 2. Supine abdominal radiograph showing a metallic object in the pelvis.Fig. 3. Intravesical knotting of a wire object (intraopera-tive view).Fig. 4. Wire object knotting (bench-side view).a frequency that each urologist and practitioner may expect to treat them. Typical circumstances that lead to self-insertion of foreign bodies are exotic impulses, mental illness or borderline personality disorder, sex-ual curiosity and play during intoxication1. Th e variety of foreign bodies inserted or externally applied to the genitourinary tract defi es imagination and includes all types of objects. Medical literature contains numerous case reports of strange foreign bodies, such as animals or parts of animals, plants and vegetables, sharp ob-jects, wire-like objects, fl uids and powders2. Foreign bodies are typically propelled into the bladder by be-ing pushed further into the urethra in an attempt to remove them3. Travel through the curve of the bul-bous urethra without causing signifi cant injuries is surprising and not yet suffi  ciently explained4.ConclusionTh e most suitable method of removing a urethral and bladder foreign body depends on the size and mo-bility of the object applied to the genitourinary tract. Although the majority of foreign bodies in the blad-der may be removed by endoscopy, open surgery may be required for larger, incrusted or solidly impacted objects.Acta Clin Croat,  Vol. 49,  No. 2,  2010 179K. Krpina et al.  An unusual case of acute urinary retention SažetakNEUOBIČAJENI SLUČAJ AKUTNOG ZADRŽAVANJA MOKRAĆEK. Krpina, S. Sotošek, R. Oguić, A. Maričić, M. Valenčić i Ž. FučkarMuškarac u dobi od 47 godina upućen je na hitni odjel naše bolnice zbog akutnog zadržavanja mokraće. Fizikalnim pregledom otkriven je električni kabel koji je dijelom bio uvučen u uretru. Radiografski pregled trbuha pokazao je metalni predmet u zdjelici, pa je bolesnik podvrgnut operacijskom zahvatu. Primijenili smo pristup suprapubičnom cistostomom i uklonili žicu iz mjehura i uretre.Ključne riječi: Strana tijela – komplikacije; Strana tijela – kirurgija; Strana tijela – psihologija; Uretra – radiografi ja; Uretra – kirurgija; Prikaz slučajaReferences1. OSCA JM, BROSETA E, SERVER G, et al. Unusual foreign bodies in the urethra and bladder. Br J Urol 1991;68:510.   2. ALI KHAN S, KAISER CW, DAILEY B, et al. Unusual foreign body in the urethra. Urol Int 1984;39:184.3. ROBERTS PN. Intravesical knotting of a urethral “catheter”. Can Med Assoc 1976;115:1199.   4. ALIABADI H, CASS AS, GLEICH P, et al. Self-infl icted foreign bodies involving lower urinary tract and male geni-tals. Urology 1985;26:12.

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Neuobičajeni slučaj akutnog zadržavanja mokraće

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